Democrats Grow Wary as Health Bill Advances

WASHINGTON — Three of the five Congressional committees working on legislation to reinvent the nation’s health care system delivered bills this week along the lines proposed by President Obama. But instead of celebrating their success, many Democrats were apprehensive, nervous and defensive.

Even as Democratic leaders and the White House insisted that the nation was closer than ever to landmark changes in the health care system, they faced basic questions about whether some of their proposals might do more harm than good.

And while senior Democrats vowed to press ahead to meet Mr. Obama’s deadline of having both chambers pass bills before the summer recess, some in their ranks, nervous about the prospect of raising taxes or proceeding without any Republican support, were pleading to slow down.

Democrats had three reasons for concern. The director of the Congressional Budget Office warned Thursday that the legislative proposals so far would not slow the growth of health spending, a crucial goal for Mr. Obama as he also tries to extend insurance to more than 45 million Americans who lack it.

Second, even with House committees working in marathon sessions this week, it was clear that Democrats could not meet their goal of passing bills before the summer recess without barreling over the concerns of Republicans and ending any hope that such a major issue could be addressed in a bipartisan manner.

Third, a growing minority of Democrats have begun to express reservations about the size, scope and cost of the legislation, the expanded role of the federal government and the need for a raft of new taxes to pay for it all. The comments suggest that party leaders may not yet have the votes to pass the legislation.

Mr. Obama tried Friday to shift the political narrative away from the grim forecasts of the Congressional Budget Office. He said he and Congress had made “unprecedented progress” on health care, with even the American Medical Association endorsing the House bill this week.

He acknowledged a treacherous path ahead, saying, “The last few miles of any race are the hardest to run,” but insisted, “Now is not the time to slow down.” And he vowed: “We are going to get this done. We will reform health care. It will happen this year. I’m absolutely convinced of that.”

On Capitol Hill, the picture is more complex. Representative Jared Polis, a freshman Democrat from Colorado who voted against the bill approved Friday in the Education and Labor Committee, said he worried that the new taxes “could cost jobs in a recession.”

To help finance coverage of the uninsured, the House bill would impose a surtax on high-income people and a payroll tax — as much as 8 percent of wages — on employers who do not provide health insurance to workers.

Mr. Polis said these taxes, combined with the scheduled increase in tax rates resulting from the expiration of Bush-era tax cuts, would have a perverse effect. “Some successful family-owned businesses would be taxed at higher rates than multinational corporations,” he said.

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President Obama discussing health care reform at the White House on Friday.Credit
Doug Mills/The New York Times

In a letter to the House speaker, Nancy Pelosi, Mr. Polis and 20 other freshman Democrats said they were “extremely concerned that the proposed method of paying for health care reform will negatively impact small businesses, the backbone of the American economy.”

And in the latest sign of lawmakers’ chafing at Mr. Obama’s ambitious timetable, a bipartisan group of six senators, including two members of the Finance Committee, sent a letter to Senate leaders pleading with them to allow more time.

“While we are committed to providing relief for American families as quickly as possible,” they wrote, “we believe taking additional time to achieve a bipartisan result is critical for legislation that affects 17 percent of our economy and every individual in the United States.”

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The group included three senators, Ben Nelson, Democrat of Nebraska; and Olympia J. Snowe and Susan Collins, Republicans of Maine, who met with Mr. Obama at the White House this week and urged him not to rush the bill.

“The legislative process right now is going in the wrong direction,” said Senator Joseph I. Lieberman, the Connecticut independent, who also signed the letter. “I think it’s extremely doable to get this done before the end of the year. But just to try to get it passed in the Senate before we leave for the August recess seems just about impossible. It’s just too big a bill.”

The House education committee approved the bill, 26 to 22, on Friday morning, after an all-night session. Three Democrats crossed party lines and voted no.

The vote came eight hours after the House Ways and Means Committee approved a nearly identical bill, 23 to 18, with 3 Democrats voting no. On Wednesday, the Senate health committee approved a generally similar bill on a party-line vote, 13 to 10.

The House and Senate bills would require insurers to take all applicants and vastly expand coverage, with federal subsidies for millions of people.

But the director of the Congressional Budget Office, Douglas W. Elmendorf, testified on Thursday that doing so would come at a steep cost and that the proposals would not curb the rise in health spending by the federal government, which he called “unsustainable.”

A budget office analysis released Friday said the House bill would “result in a net increase in the federal budget deficit of $239 billion” over 10 years, partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors.

“We are not doing enough to reform the health care delivery system, to change the incentives so reimbursement will be based on the value, rather than the volume, of services,” Representative Ron Kind of Wisconsin said.

Others worry that a government-run health plan, to be created under the House bill, would underpay doctors and hospitals by using Medicare reimbursement rates. “I have a serious problem with the public plan in this bill because it’s based on Medicare rates,” Representative Earl Pomeroy of North Dakota said. “North Dakota is underpaid by Medicare.”

Mr. Obama said he was confident that Congress and the White House would reach a deal on how to pay for the bill, and lower health care spending over the long term — an optimistic view that not all lawmakers share. But on one of Mr. Obama’s points, there was no dispute: “We’re going to be putting in a lot more hours,” the president said. “There are going to be a lot more sleepless nights.”

A version of this news analysis appears in print on , on Page A1 of the New York edition with the headline: Democrats Grow Wary as Health Bill Advances. Order Reprints|Today's Paper|Subscribe